Continuing the Condom Conversation

When we launched the first call to develop the Next Generation of Condom through our Grand Challenges Explorations initiative, we weren’t quite prepared for the media onslaught that followed. Various media outlets found our efforts amusing, exciting, or a waste of time, and we provided good fodder for late-night jokes and even inspired a condom slingshot applicator! Fortunately, we also received great ideas that could eventually address the need for new condoms that men and women will actually want to use. As we issue the second round of our GCE call to Develop the Next Generation of Condom, we want to thank everyone who was part of the conversation, either by submitting applications, reading the news stories, or even just having a conversation with partners, family, or friends on this important topic. We hope you’ll continue the conversation with us as we seek new ideas for next generation condoms, along with ways to increase their uptake and use throughout the developing world.

With the heightened global conversation around condoms and based on the ideas submitted to the first GCE call, we are targeting our second call for proposals around several different problems.

First, as we discussed in the previous GCE topic language and blog, we are seeking solutions that address sensation. Loss of sensation, either real or perceived, is one of the main reasons men prefer not to wear condoms during intercourse. The common analogy is wearing a condom is like ‘taking a shower with a raincoat on’ – meaning the whole point of the activity, be it a shower or sexual intercourse, is negated by wearing the raincoat, or in the case of sex, the condom. As the raincoat blocks the water from cleaning your body in the shower, condoms are perceived to block sensation to the penis during sex. And how might we address this raincoat situation? We’re open to great new ideas that might include things like changing the fit of the condom, trying different thicknesses, textures, or amounts and types of lubrication to increase or decrease the amount of friction felt by either partner during or simulate skin-to-skin contact while still serving as contraception and preventing sexually transmitted infections. While this list certainly isn’t exhaustive, it does illustrate the complexity and subjectivity associated with the task of enhancing sensation during the sexual experience. Is more friction or less friction better for sensation during sex? Will looser or tighter, thicker or thinner condoms provide the best sensation and incentive for use? Are these answers the same for every couple? We hope your great ideas will help to answer these questions and move us toward a world where condom negotiation is no longer an issue.

Loss of sensation, either real or perceived, is one of the main reasons men prefer not to wear condoms during intercourse.

Second, we realize that sensation may be one part of the problem, another issue we would like to address is to decrease the difficulty and uncertainty around using a condom correctly, and ease concerns of erection loss during condom donning. To that end, we are seeking solutions that decrease the difficulty of putting on (donning) condoms. The Next Generation Condom could be a solution that meets the needs of men who choose not to use condoms because they take too long to apply, or are difficult to put on in the proper direction, especially in the dark, or cause loss of erection due to having to stop and don a condom.

Third, we are seeking new ideas for female condoms, with the hope that more women would be empowered in condom negotiation if female condoms were easier to insert and more acceptable (or perhaps unnoticeable) to the male partner. Female condoms suffer from some of the same drawbacks as male condoms, particularly difficulty inserting the condom for proper use and protection. Improving the female condom in a way that makes it affordable and easy to use for all women might help empower women to take charge of their own reproductive decisions.

As with any challenge of this broad nature, we recognize there may be more than one solution that could work. We aren’t necessarily looking for a magic bullet, but we are looking for something that will radically change the dialogue about and enjoyment of safe sex!

We welcome your great ideas for the Next Generation Condom! Please keep in mind as you think and talk about next generation condoms, condom use, and condom negotiation that new condoms must work at least as well as the existing condoms; they must prevent most sexually transmitted infections and work effectively for contraception. We also hope that you consider the developing world context – what works in the US, in Europe, or in other developed world countries may not be appropriate for Senegal, South Africa, or the rest of the developing world. As such, these new technologies will need to be available at a cost appropriate to those in the developing world.

Please note, however, this call is NOT focused on new methods for delivery, promotion, or counseling for condom use. While these are critical issues to be addressed, this particular topic is focused on technology development to enable future delivery, promotion, and educational campaigns.

The original post, published March 18, 2013. The grant recipients from this original call will be announced later this year.

March 18, 2013: Reinventing the Condom

What is one of the oldest medical devices in existence? What is the most effective method of preventing sexual transmission of HIV? What medical product is so simple that it can easily be manufactured by the millions and costs just pennies? The answer to all three is the same – the condom. The fact that such a modest device, nothing more than an inert sheath of latex, is one of the most effective tools in our armamentarium against HIV infection, and additionally prevents unintended pregnancy, is frankly astounding. When used consistently and correctly, condoms are extremely effective at preventing HIV infection and unplanned pregnancy.

Quite simply, condoms save lives. But if condoms are so marvelous, why are we seeking ideas for the Next Generation of Condoms in our current Round of Grand Challenges Explorations?

It may seem obvious, but the success and impact of any public health tool hinges on that tool being used consistently and correctly by those who need it. Vaccines sitting on shelves don’t prevent disease. New tuberculosis drug regimens won’t help if patients stop taking them halfway through the necessary days. Likewise, the potential value of condoms is limited by inconsistent use.

Women, particularly those in high risk groups such as commercial sex workers, often face difficulties negotiating condom use; the fact that the term “condom negotiation” even exists and is so common in discussions about HIV prevention or reproductive health speaks to the central shortcoming of our current generation of condoms. The undeniable, and unsurprising, truth is that most men prefer sex without a condom, while the risks related to HIV infection and complications of unplanned pregnancy are disproportionately borne by their partners.

It may seem obvious, but the success and impact of any public health tool hinges on that tool being used consistently and correctly by those who need it.

Ultimately, the field is moving toward new classes of products, referred to as Multi-purpose Prevention Technologies (MPTs) that will meet multiple of the sexual and reproductive health needs of men and women, including HIV prevention and contraception. These might include combination vaginal rings, co-administered or co-formulated injectable products, or new “on demand” products like fast-dissolving vaginal films. A number of concepts are already being actively pursued by product development organizations (please see the CAMI database). While potentially transformational, most of these products are high risk, years away from being available, and their path through development, regulatory approval, and delivery remains unclear.

In the meantime, we have a product that is safe and effective, but underutilized. What if we could develop a condom that would provide all the benefit of our current versions, without the drawbacks? Even better, what if we could develop one that was preferred to no condom?

While there have been few modification to condom design that have had substantial impact on the condom market, there are opportunities for taking a radically different approach to condoms being pursued currently. Researchers at the University of Washington are developing a condom using a technique known as electrospinning, which creates tightly woven fabric out of nanometer-sized polymer strands and which could be used to deliver spermicidal or microbicidal agents in addition to providing a barrier.

Origami Condoms provides an excellent example of a private enterprise focused on new condom design to promote consistent use by emphasizing the sexual experience.

The idea of a condom that men would prefer to no condom is a revolutionary idea, but we know more today about sexual function than at any time in the past, and advances in relevant disciplines such as neuroscience, vascular biology, urology, reproductive biology, materials science, and other fields can contribute to new and unconventional approaches. We hope this GCE call will provide a thought-provoking challenge to innovators from many areas who may never have thought about how they could build a better condom.

Author

Stephen Ward currently serves as a program officer within the Bill & Melinda Gates Foundation’s Discovery & Translational Sciences team, focused on efforts in early-stage drug discovery. In his time at the foundation, Stephen has been closely involved
in the Grand Challenges Explorations (GCE) program for providing staged support for innovative new concepts in global health, as well as working with foundation’s Family Planning, HIV, Malaria, and Neglected Infectious Diseases teams.

Reader Comments

Connect With Us

"Our desire to bring every good thing to our children is a force for good throughout the world. It’s what propels societies forward." —Melinda Gates

The Global Fund has helped to deliver more than 190 million bed nets to protect families from malaria.

"The world faces a clear choice. If we invest relatively small amounts, many more poor farmers will be able to feed their families." —Bill Gates, 2012 Annual Letter

"When it come to global health, Bill and I are optimists—but we're impatient optimists. Tremendous progress is being made. But there is still so much we're impatient to see done." —Melinda French Gates

In Senegal, 80% of households now have a bed net, helping the number of malaria cases there drop 50% in a single year.